Magellan Health has established itself as a leader in value-based care in mental health. As a health plan focusing on special populations, the company has been at the forefront of innovative care models that prioritize patient outcomes over traditional fee-for-service systems. Through its managed care subsidiary, Magellan Healthcare, the company has inked several high-profile value-based care in mental health contracts, including partnerships with autism providers Kyo Autism and Invo Healthcare. This shift to value-based care in mental health represents a significant transformation in the way mental health services are delivered, emphasizing measurable outcomes that improve the quality of care.
Dr. Caroline Carney, President of Behavioral Health and Chief Medical Officer at Magellan Health, has been a strong advocate for this model, believing that value-based care in mental health can fundamentally change the way providers deliver care. She shared her insights with Behavioral Health Business, explaining that the organization has been using value-based care strategies in behavioral health since the early stages. “We started using value-based care in mental health to work with facilities and large provider groups around evidence-based metrics,” Dr. Carney explained. This early adoption allowed Magellan Health to develop a robust framework for measuring and incentivizing care quality, ultimately leading to better patient outcomes.
Magellan Health’s journey with value-based care in mental health began with the introduction of contracts that incentivized providers to meet specific metrics, such as ensuring follow-up care after inpatient hospitalization and managing medications for patients on antipsychotics. Initially, these contracts focused on rewarding providers with upside bonuses for meeting quality metrics, with no downside risk. Over time, Magellan Health has expanded the scope of its efforts to include outpatient providers and is working toward introducing downside risk for underperforming providers. Dr. Carney believes that while value-based care is still in its early stages, the results thus far have been promising, with substantial improvements in provider engagement and care quality.
“Our network and analytics team worked very closely to create a dashboard of metrics that we rolled out initially with inpatient providers to ensure that follow-up care and transition of care was done well,” Dr. Carney explained. This dashboard allowed Magellan to monitor and measure the success of value-based care in mental health initiatives and ensure that providers were meeting key performance indicators. The results have been encouraging, with Magellan reporting that the implementation of these measures has significantly improved group engagement and the overall quality of care. The company’s commitment to using evidence-based metrics to guide care has proven successful in fostering better outcomes for patients and incentivizing providers to prioritize high-quality care.
The Importance of Measurement-Informed Care and Collaborative Models
As part of its efforts to improve care delivery, Magellan Health has been a strong proponent of measurement-informed care. This approach integrates real-time data and patient assessments into the decision-making process, ensuring that treatment plans are aligned with evidence-based practices. Measurement-informed care has become a cornerstone of Magellan’s collaborative care models, which combine the expertise of behavioral health professionals with primary care providers to deliver comprehensive care.
However, Dr. Carney acknowledges that implementing measurement-informed care can be challenging at the individual provider level. Different health plans and providers may have varying ideas about which metrics are most important, creating confusion and additional burdens for clinicians. Despite these challenges, Magellan remains committed to developing collaborative care models that leverage measurement-informed care to improve patient outcomes. “We need to work closely with the federal government, the state governments, and other plans to holistically align around those key metrics,” Dr. Carney stated, emphasizing the need for greater collaboration and standardization across the industry.
One of the key challenges Magellan Health faces in promoting measurement-informed care is the fact that different providers may have different priorities. For example, a therapist might have a strong relationship with a patient and feel that their care is effective, but without the proper measurements in place, it may not be clear if the treatment is truly making a difference. “Therapy is supposed to be hard,” Dr. Carney noted, highlighting that the therapeutic process often requires difficult but necessary interventions that go beyond surface-level comfort. By using data to guide treatment decisions, Magellan hopes to ensure that patients receive the most effective interventions, even if they are not always the easiest or most comfortable options.
Innovating Behavioral Health Care: New Therapies, Parity, and Patient Safety
Looking ahead, Magellan Health sees several areas within behavioral health care that are ripe for innovation. One of the most exciting areas of development is the use of new therapies, such as psychedelics, in the treatment of mental health disorders. While research into psychedelic therapies is still in its early stages, Magellan is closely monitoring this area and remains open to the potential benefits of these novel treatments. “A lot of work is being done, and there’s a lot of pressure to approve [psychedelics], but there is a very limited amount of science at this time,” Dr. Carney acknowledged. The key challenge, according to Dr. Carney, is finding the right balance between advancing innovative therapies and ensuring patient safety. As new treatments are brought to market, it’s crucial that they undergo rigorous testing and are used in ways that minimize the risk of abuse and harm.
In addition to exploring new treatment options, Dr. Carney stressed the importance of maintaining parity in behavioral health care. Parity, the concept of ensuring that mental health care is treated on an equal footing with physical health care, has long been a cornerstone of Magellan Health’s approach. However, Dr. Carney cautioned that there needs to be careful consideration when loosening standards to increase access to care. “We need to be careful about loosening parity so much, as it allows individuals to get non-evidence-based care, or it potentially opens the door to waste, abuse and fraud while driving up the cost of medically unnecessary care,” she explained. The goal is to ensure that patients have access to high-quality, evidence-based care without compromising their safety or driving up costs unnecessarily.
Legislative Changes and the Future of Behavioral Health
As the behavioral health landscape continues to evolve, Magellan Health is closely monitoring several pieces of legislation that could impact the industry. Dr. Carney highlighted several key areas of focus, including funding for adolescent and young adult services, efforts to combat the opioid epidemic, and the expansion of telehealth services. The COVID-19 pandemic has accelerated the use of telehealth, and while some patients have returned to in-person visits, the demand for remote care remains high. Magellan is paying close attention to how telehealth prescribing, particularly for medication-assisted therapy, is regulated at the state and federal levels.
Another area of focus is the continued fight against the opioid epidemic, especially in the context of fentanyl use. Dr. Carney emphasized that addressing the opioid crisis requires a multifaceted approach that goes beyond simply regulating prescription practices. “This is a much broader problem now, and solving it needs to involve many more tactics,” she said.
Lastly, Magellan is closely monitoring legislation around collaborative care and its reimbursement across the country. The company has been an early adopter of this evidence-based model and believes that it holds significant promise for improving patient outcomes. Dr. Carney emphasized that while Medicare already covers collaborative care, many states do not. She hopes that state-level reimbursement for collaborative care will increase, allowing more patients to benefit from this integrated approach to mental health and primary care.
A Vision for the Future
Magellan Health’s commitment to value-based care in mental health and innovative solutions is shaping the future of mental health care. By focusing on patient outcomes, measurement-informed care, and evidence-based practices, the company is helping to redefine what’s possible in behavioral health. As new treatments and technologies continue to emerge, Magellan Health will remain at the forefront of efforts to improve care delivery and ensure that patients receive the highest quality care possible.
